Meet Your Feet

1. There are 26 Bones in each foot. Together they make up one quarter of the total number of bones in the entire body.
2. There are 33 joints and 20 muscles that help move and make the foot flexible.
3. There are two arches in the foot. A transverse or metatarsal arch which runs across the ball of the foot. and the longitudinal arch, running from the heel to the ball of the foot, makes up the instep or arch. This bears most of the weight of the foot on standing. This arch also tends to flatten or extend as weight is applies.
4. You apply two times your body weight to each heel when it strikes the ground in a normal "site seeing" type of gait.
5. Flat footed means there is no longitudinal arch when the foot is not bearing any weight. Some people are considered to have flexible flat feet because when they stand on their feet the arch collapses and the arch appears flat.
6. Some people have a high arch foot call "Pes Cavus". This type of foot is not a common as the flat or "Pes Plannus" foot. Both types of extremes flat foot or high arch foot can lead to or cause problems.

7. Babies often appear to be flat footed. This is due to a fat pad that they are born with to help support the arch until such time as the bones in their feet are strong enough to support their body weight.

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Foot Health and Aging

Medicine and health awareness have progressed so rapidly since 1900 that life expectancy of the average American has increased by about 30 years. Older persons have become an increasingly significant proportion of our total population -- and their numbers are growing rapidly. In 1900, for example, there were three million Americans aged 65 or older. In the year 2000, older people outnumber children for the first time in history.

If older people are to live useful, satisfying lives, they must be able to move about. Mobility is a vital ingredient of the independence that is cherished by our aging population, and foot ailments make it difficult or impossible for them to work or to participate in social activities.

According to the US National Center for Health Statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. As if foot problems weren't enough of a nuisance, they can also lead to knee, hip, and lower back pain that undermine mobility just as effectively. The NCHS says one-fourth of all nursing home patients cannot walk at all and another one-sixth can walk only with assistance.

Mirror of Health

The human foot has been called the mirror of health. Foot doctors, or doctors of podiatric medicine (DPMs), are often the first doctors to see signs of such systemic conditions as diabetes, arthritis, and circulatory disease in the foot. Among these signs are dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration. Always seek professional care when these signs appear.

Foot Problems Can Be Prevented

For reasons that are difficult to fathom, many people, including a lot of older people, believe that it is normal for the feet to hurt, and simply resign themselves to enduring foot problems that could be treated.

There are more than 300 different foot ailments. Some can be traced to heredity, but for an aging population, most of these ailments stem from the cumulative effect of years of neglect or abuse. However, even among people in their retirement years, many foot problems can be treated successfully, and the pain of foot ailments relieved.

Whether due to neglect or abuse, the normal wear and tear of the years causes changes in feet. As persons age, their feet tend to spread, and lose the fatty pads that cushion the bottom of the feet. Additional weight can affect the bone and ligament structure. Older people, consequently, should have their feet measured for shoe sizes more frequently, rather than presuming that their shoe sizes remain constant. Dry skin and brittle nails are other conditions older people commonly face. Finally, it's a fact that women, young and old, have four times as many foot problems as men, and high heels are often the culprits.

Observing preventive foot health care has many benefits. Chief among them are that it can increase comfort, limit the possibility of additional medical problems, reduce the chances of hospitalization because of infection, and lessen requirements for other institutional care.

Keep Them Walking

Studies show that care for a bedridden patient costs much more than care for an ambulatory patient. In their private practices and in foot clinics, podiatric physicians are providing services designed to keep older people on their feet, and they serve in hospitals and nursing homes across the country.

Records indicate that amputations and other forms of surgery due to infections of the feet, many brought about by diabetes, have been significantly reduced in recent years because of early diagnosis and treatment. Further reduction in this area is a goal of Healthy People 2010, a US Department of Health and Human Services campaign endorsed by podiatric physicians, to encourage understanding and application of preventive medical practices.

Foot Health Tips

• Properly fitted shoes are essential; an astonishing number of people wear shoes that don't fit right, and cause serious foot problems.
  
• A shoe with a firm sole and soft upper is best for daily activities.
  
• Shop for shoes in the afternoon; feet tend to swell during the day.
  
• Walking is the best exercise for your feet.
  
• Pantyhose or stockings should be of the correct size and preferably free of seams.
  
• Do not wear constricting garters or tie your stockings in knots.
  
• Never cut corns and calluses with a razor, pocket knife, or other such instrument; use over-the-counter foot products only with the advice of a podiatrist.
  
• Bathe your feet daily in lukewarm (not hot) water, using a mild soap, preferably one containing moisturizers, or use a moisturizer separately. Test the water temperature with your hand.
  
• Trim or file your toenails straight across.
  
• Inspect your feet every day or have someone do this for you. If you notice any redness, swelling, cracks in the skin, or sores, consult your podiatrist.
  
• Have your feet examined by a DPM at least twice a year.

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Top 10 Foot Problems

Issued by the Foot Health Foundation of America - a national health initiative of the American Podiatric Medical Association For more information, call 1-800-615-0807.

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History of Shoes

The first shoe was a simple skin sandal that protected the foot from cold and injury. But since those early times, shoes have more often been worn for status and style than comfort and function. Early Greek and Oriental actors used platform shoes to make the main character on stage stand above the supporting actors.

In the 16th century England, male dandies wore shoes with extremely pointed toes. Chinese upper-class women years ago, although it nearly crippled them, would bind their feet so they could wear tiny shoes (a sign of being well bred). Even today some of them still bind their feet.

Today's high heels are almost as rough on the modern women's foot, so it's no wonder that 80 percent of all foot problems occur in their feet.

Men's feet have their problems too though. The stress and inactivity of contemporary life often lead to obesity. These extra pounds added to the out-of-shape weekend athlete and not always wearing the right shoe for the right occasion causes men's feet to develop many problems.

Fortunately, most foot problems can be prevented.

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Foot Health

The human foot is a biological masterpiece. Its strong, flexible, and functional design enables it to do its job well and without complaint - if you take care of it and don’t take it for granted.

The foot can be compared to a finely tuned race car, or a space shuttle, vehicles whose function dictates their design and structure. And like them, the human foot is complex, containing within its relatively small size 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints, and a network of more than 100 tendons, muscles, and ligaments, to say nothing of blood vessels and nerves.

Tons of Pressure
The components of your feet work together, sharing the tremendous pressures of daily living. An average day of walking, for example, brings a force equal to several hundred tons to bear on the feet. This helps explain why your feet are more subject to injury than any other part of your body.

Foot ailments are among the most common of our health problems. Although some can be traced to heredity, many stem from the cumulative impact of a lifetime of abuse and neglect. Studies show that 75 percent of Americans experience foot problems of a greater or lesser degree of seriousness at some time in their lives; nowhere near that many seek medical treatment, apparently because they mistakenly believe that discomfort and pain are normal and expectable.

There are a number of systemic diseases that are sometimes first detected in the feet, such as diabetes, circulatory disorders, anemia, and kidney problems. Arthritis, including gout, often attacks foot joints first.

Specialized Care
Your feet, like other specialized structures, require specialized care. A doctor of podiatric medicine can make an important contribution to your total health, whether it is regular preventive care or surgery to correct a deformity.

In order to keep your feet healthy, you should be familiar with the most common ills that affect them. Remember, though, that self treatment can often turn a minor problem into a major one, and is generally not advisable. You should see a podiatric physician when any of the following conditions occur or persist.

Athlete’s foot is a skin disease, usually starting between the toes or on the bottom of the feet, which can spread to other parts of the body. It is caused by a fungus that commonly attacks the feet, because the wearing of shoes and hosiery fosters fungus growth. The signs of athlete’s foot are dry scaly skin, itching, inflammation, and blisters. You can help prevent infection by washing your feet daily with soap and warm water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture. Athlete’s foot is not the only infection, fungal and otherwise, which afflicts the foot, and other dry skin/dermatitis conditions can be good reasons to see a doctor of podiatric medicine if a suspicious condition persists.

Blisters are caused by skin friction. Don’t pop them. Apply moleskin or an adhesive bandage over a blister, and leave it on until it falls off naturally in the bath or shower. Keep your feet dry and always wear socks as a cushion between your feet and shoes. If a blister breaks on its own, wash the area, apply an antiseptic, and cover with a sterile bandage.

Bunions are misaligned big toe joints which can become swollen and tender. The deformity causes the first joint of the big toe to slant outward, and the big toe to angle toward the other toes. Bunions tend to run in families, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe. There are conservative and preventive steps that can minimize the discomfort of a bunion, but surgery is frequently recommended to correct the problem.

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas. Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist’s instructions.

Foot odor results from excessive perspiration from the more than 250,000 sweat glands in the foot. Daily hygiene is essential. Change your shoes daily to let each pair air out, and change your socks, perhaps even more frequently than daily. Foot powders and antiperspirants, and soaking in vinegar and water, can help lessen odor.

Hammertoe is a condition in which any of the toes are bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes or socks that cramp the toes. Avoid pressure on the toes as much as possible. Surgery may be necessary to realign the toes to their proper position.

Heel pain can generally be traced to faulty biomechanics which place too much stress on the heel bone, ligaments, or nerves in the area. Stress could result while walking or jumping on hard surfaces, or from poorly made footwear. Overweight is also a major contributing factor. Some general health conditions - arthritis, gout, and circulatory problems, for example - also cause heel pain.

Heel spurs are growths of bone on the underside of the heel bone. They can occur without pain; pain may result when inflammation develops at the point where the spur forms. Both heel pain and heel spurs are often associated with plantar fasciitis, an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Treatments may range from exercise and custom-made orthotics to anti-inflammatory medication or cortisone injections.

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers. If painful or infected, your podiatric physician may remove the ingrown portion of the nail; if the condition reoccurs frequently, your podiatrist may permanently remove the nail.

Neuromas are enlarged, benign growths of nerves, most commonly between the third and fourth toes. They are caused by bones and other tissue rubbing against and irritating the nerves. Abnormal bone structure or pressure from ill-fitting shoes also can create the condition, which can result in pain, burning, tingling, or numbness between the toes and in the ball of the foot. Conservative treatment can include padding, taping, orthotic devices and cortisone injections, but surgical removal of the growth is sometimes necessary.

Warts are caused by a virus, which enters the skin through small cuts and infects the skin. Children, especially teenagers, tend to be more susceptible to warts than adults. Most warts are harmless and benign, even though painful and unsightly. Warts often come from walking barefooted on dirty surfaces or littered ground. There are several simple procedures which your podiatric physician might use to remove warts.

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Medicare

Podiatry
Podiatric medicine is a branch of the health sciences devoted to the medical and surgical care of the foot and ankle, and related or governing structures. A doctor of podiatric medicine (DPM) specializes in the prevention, diagnosis, and treatment of foot and ankle disorders resulting from injury or disease. A DPM makes independent medical judgments, prescribes medications, and when necessary performs surgery.

Podiatrists help our aging population to remain active and independent by keeping them ambulatory. Congress recognized this important relationship between foot health and general health when it included the services of podiatric physicians in the Medicare legislation.

Misconceptions of Medicare
Medicare coverage can often be confusing. The rules and regulations can easily be misunderstood by patients. One misconception is that Medicare covers only surgical procedures, and not medical care or routine foot care.

In truth, Medicare will cover routine foot care. According to the Medicare Rules and Regulations Manual, "Certain foot care procedures that are generally considered to be routine -- e.g., cutting or removal of nails, calluses or corns -- may pose a hazard when performed by a nonprofessional person on patients with a systemic condition that has resulted in severe circulatory problems or areas of desensitization in the legs or feet. Routine foot care performed under these circumstances is covered."

The manual also states, "Services ordinarily considered routine are also covered if they are performed as a necessary and integral part of otherwise covered services such as the diagnosis and treatment of diabetic ulcers, wounds, and infections."

Treatment of diabetic foot conditions, both medically and surgically, is therefore covered by Medicare. Treatment of broken toes, of burns, and of arthritic conditions -- gout, for example -- are others. (The misconceptions that Medicare covers only surgery may be caused by the fact that the Medicare code numbers assigned to diabetic treatment such as that mentioned in the manual, and other nonsurgical procedures, are listed under the "surgical" section of the code book.)

Coverage Under Medicare
If you have signed up for medical insurance (Part B) under Medicare, you are covered for certain services of podiatrists and other doctors for:

1. Medical and surgical services in the hospital, skilled nursing facility, office, or your home. The same action also provided that podiatrists can certify and recertify medical necessity for hospitalization, skilled nursing care, and home health care.
2. Payment for routine foot care may be made for such care only when it would be hazardous to the health of the patient if self-treatment were performed. For example, when a beneficiary is under the care of a doctor for diabetes, circulatory ailments or certain other conditions, and evidences complicating local symptoms, routine foot care is a covered service.
3. Other prescribed health services, including diagnostic x-ray, surgical treatment, fracture casts, and leg or ankle braces that are attached to the outside of the shoe.
4. Drugs which cannot be self-administered, and which are administered to you as a part of professional services.
5. Full reasonable charges for radiology and pathology services as a bed patient in a hospital, if you have both hospital and medical insurance.

Certain foot care services are not covered, no matter whether they are performed by podiatrists, medical doctors, or osteopaths. They are:

1. Routine foot care. This includes the cutting or removal of corns or calluses, trimming of nails, and routine hygienic care, except as noted above.
2. Treatment of flat-foot conditions, including arch supports.
3. Treatment of partial dislocations.

Reimbursement Under Medicare

Your medical insurance (Part B of Medicare) helps pay for the services of podiatrists and other doctors, out-patient hospital services, medical services and supplies, and other health care services.

Subscribers to medical insurance pay a monthly premium, and the Federal government covers the remaining costs of the program. Medical insurance pays 80 percent of the Medicare-allowed amount, after the individual pays an annual deductible for covered services connected with the diagnosis or treatment of illness and injuries. Payment for services of a podiatrist or another doctor can be made as follows:

1. 1. If you and your podiatrist agree, application for the medical insurance payment for covered services will be made by the podiatrist who will receive the payment directly from Medicare.
2. If you desire it, you may pay the doctor directly, and the medical insurance payment can be made directly to you.

In either case, you are responsible for the annual deductible and the 20 percent coinsurance amounts. Under either of these two payment options, the podiatrist is required to complete the necessary Medicare claim forms for you.

Note that, in some cases, you may also be charged amounts in excess of the Medicare-allowed fees, and for services not covered under the Medicare program.

See "Your Medicare Handbook" for more information.

Prompt Care Of Foot Disorders

With advancing years, the skin and nails of the feet frequently become dry and brittle, and numbness and discoloration often are present. These may be the first signs of such serious conditions as diabetes, arthritis, and circulatory disease. Ignoring these symptoms and failing to seek prompt professional medical care when they appear can have serious consequences for patients, especially the elderly.

Foot Problems Can Be Prevented

Whether the older person lives at home or elsewhere, preventive foot care can:

• Increase comfort
• Improve or maintain mobility and independence
• Limit the possibility of additional medical problems
• Reduce the chances of hospitalization
• Lessen requirements for other institutional care

Consult Your Podiatrist

You may receive treatment from your podiatrist in the office, your home, the hospital, a nursing home, or an extended care facility. Always consult your podiatrist when you have questions about foot conditions or what is covered by Medicare.

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Proper Footwear Can Reduce Foot Problems

From ancient Egyptian times down through the centuries, footwear has been designed to meet mankind's real and perceived needs -- protection, support, comfort, sturdiness, stylishness, and the rest.

Today, there is an almost endless variety of styles and materials can pose a major dilemma when it's time to buy a pair of shoes. The dilemma can be minimized, however, if you concentrate on the health aspects of the modern shoe: well-fitting, well-made, and used properly, it has an inherent capacity to help reduce foot problems.

Feet bear the tremendous pressures of daily living. An average day of walking brings a force equal to several hundred tons to bear on the feet. They are subject to more injury than any other part of the body, highlighting the need to protect them with proper footwear.

Children, women, men, and athletes all have different shoe requirements, and such requirements will vary considerably across a wide range of activities.

Doctors of podiatric medicine are health care professionals trained in the care of the foot and ankle. They are fully qualified to recommend selection of the right pair of shoes, or address other aspects of foot health, for all members of the family.

Children's Shoes
When a child begins to walk, shoes generally are not necessary, Allowing an infant to go barefooted indoors, or to wear only a pair of socks, helps the foot grow normally and develop its musculature and strength, as well as the grasping ability of toes.

As children grow more active, and their feet develop, the need for shoes becomes apparent. It becomes necessary to change shoe sizes at a pace which frequently surprises and even dismays parents, to allow room for growth.

Though fit is the most important consideration, function is also pertinent. For youngsters who have reached the stage of walking stability, footwear with crepe or rubber soles helps cushion impact on growing feet better than the soles of dressier shoes with thinner soles.

Women's Shoes
Women, inhabiting the work force in greater numbers, inflict more punishment on their feet, in part from improper footwear they feel obliged to wear at work, that can bring about unnecessary foot problems.

Some of those problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches). Doctors of podiatric medicine believe such heels are orthopedically unsound, and attribute medical, postural, and safety problems to their use.

To relieve the abusive effects of high heels, women can limit the time they wear them, alternating with good quality sneakers or flats for part of the day.

They can also vary heel height. There are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for work and social activities, that blend fashion considerations and comfort, offering pumps with athletic shoe-derived construction, reinforced heels, and wider toe room.

Activity has a bearing on the considerations; wearing the right shoe for a particular activity is probably as important a factor in the choice of shoes as any.

Perhaps the best shoe for women, from an orthopedic viewpoint, is a walking shoe with laces (not a slip-on), a Vibram-type composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height -- even though such a shoe may be scorned in fashion circles.

Men's Shoes
The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap designs. Also suitable are slip-ons, dressy loafers, and low, dress boots.

Men as well as women should buy shoes for work, leisure, and special activities, matching the shoe to the activity.

Male (and female) office workers should earmark three to five pairs of shoes for business hours -- general oxfords and loafers for men; pumps and oxfords for women. Cushioned-sole shoes that give good support are essential for those who spend most of their working days on their feet.

There is no question about the need for foot protection for those who work in heavy industry. Safety shoes and boots -- those that are waterproof or water-resistant, with insulated steel toe caps and soles of non-conducting materials -- help prevent injuries to the feet, and reduce the severity of injuries that do occur.

Shoes for Athletics
Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete; nevertheless, it's a good idea to use the correct shoe for each sport. Probably a more important consideration is the condition of the shoe -- don't wear any sports shoes (or any shoes) beyond their useful life.

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved.

For example, a running shoe is built to accommodate the impact that concentrates on the forefoot, while a tennis shoe is made to give relatively more support to the ankles, and permit sudden stops and turns.

Buying Tips

• Have your feet measured while you're standing.
  
• Always try on both shoes, and walk around the store.
  
• Always buy for the larger foot; feet are seldom precisely the same size.
  
• Don't buy shoes that need a "break-in" period -- shoes should be comfortable immediately.
  
• Don't rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers' sizing molds) also vary.
  
• Shop for shoes later in the day; feet tend to swell during the day, and it's best to be fitted when they are at their largest.
  
• Be sure that shoes fit well -- front, back, and sides -- to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.
  
• Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
• Try on shoes while you're wearing the same type of socks or stockings you expect to wear with the shoes.

Shoe Care
For longer service, keep shoes clean and in good repair. Avoid excessive wear on heels and soles. Give your shoes a chance to breathe by rotating their use. Never wear hand-me-down shoes (this is especially important for children).

Seal of Acceptance
The American Podiatric Medical Association awards its Seal of Acceptance to a wide variety of shoes (and shoe-related products), which have been deemed to enhance a consistently applied program of daily foot care and regular professional treatment.

The intent of such endorsements is to make a significant contribution to the foot health and foot health education of the public.

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Shoe Choosing

The wrong shoes can cause or aggravate foot ailments. The right shoes can often prevent, never correct, problems. Follow the checklist below when buying shoes.

Construction:

• Leather is best because it breathes and molds to your foot. Cheap canvas is fine for fast-growing kids.
• Soles should be strong and flexible with a good gripping surface.
• Insoles should be cushioned to absorb the jolts of walking on hard surfaces.
• Arch supports distribute weight over a wider area. Rigid shanks also give added support.
• High heels are fun and look good, but they should not be worn too long at a stretch or for much walking. They not only cramp the toes, they change body posture, making backaches and other foot problems more likely.

FIT:

• Only you can tell if shoes fit. If they aren't comfortable, don't buy them!
• Don't plan on shoes stretching with wear. If you own shoes that are too tight, ask your shoe repair shop if they can be stretched.
• Because feet spread with age, have your feet measured every time you buy new shoes. Always buy shoes for the BIGGEST foot.
• Shop for shoes in the late afternoon. Feet swell to their largest then.
• Size depends on the shoe make and style, too. Don't insist you always wear one size if the next feels better.
• The toe box should be roomy enough so you can wiggle all your toes.
• Your forefoot should NOT be wider than your shoe.
• The heel should fit snugly and in the instep should not gape open.
• If you can't find shoes that fit, ask your PODIATRISTS for advice.

SHOES FOR CHILDREN

• Good shoes are especially important to avoid problems in developing feet.
• Because shoes serve only to protect children's feet, none are needed before a child can walk on his own.
• High-topped infant shoes do help children to start walking early. This can be bad because the bones in the feet may not be ready to support the weight of the child's body. When the bones of the foot are strong enough then the child will walk. So don't force the child to walk by using high-topped shoes.
• Check often to be sure shoes aren't too small. Children's feet are so flexible they can be crammed into shoes two sizes too small, and the kid won't complain.
• Try and find the softest most flexible shoe for the child to wear from birth until age two. Remember if you as an adult struggle to bend the toes of the child's shoe how can a 20 lb. child's foot bend the shoe?

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What is a Podiatrist?

Podiatric Physicians: Podiatrists are doctoral-level health care providers who provide medical, surgical, and biomechanical treatment to the human foot, ankle, and associated structures. They receive a four year post-baccalaureate medical education which is comprehensive to the body pre-clinically and comprehensively specialized to the foot and its interactions with the whole body clinically. Podiatric residency training is highly specialized, emphasizing, respectively; medical, surgical and biomechanical skill, and can be up to fours years in length. Board certification is provided in each of these respective Podiatric subspecialties.

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